HomeMy WebLinkAbout01-1009
PETITION FOR GRANT OF LETTERS
. Estate of HENRY J SOUDER
No. ~/-/)/ - /rYJ9
also known as
, Deceased
Social Security No. 180607994
Petitioner(s), who is/are 18 years of age or older, apply)ies) for :
(CdMPLETE "A" OR "B" BELOW:)
o
A. Probate and Grant of Letters and aver that Petitioner(s) is/are the execut
Decedent, dated and codicil(s) dated
named in the Last Will of the
State relevant circumstances, e.g., renunciation, death of executor, etc
Except as follows, Decedent did not marry, was not divorced and did not have a child born or adopted after execution of the documents offered
for probate; was not the victim of a killing and was never adjudicated incapacitated:
[)
B. Grant of Letters of Administration
(c.l.a., d.b.n.c.l.a.: pendente lite, durante absentia; durante minoritate)
Petitioner(s) after a proper search haslhave ascertained the Decedent left no Will and was survived by the following spouse
(if any) and heirs:
Name
Relationship
Residence
ERNEST J SOUDER
FATHER
870 SHIPPENSBURG RD,NEWVILLE
(COMPLETE IN ALL CASES:) Attach additional sheets if necessary. ~ f.t
Decedent was domiciled at death in CUMBERLAND County, ~~Syl
residence at 870 SHIPPENSBURG RD,NORTII N[VfrOt~,rA,17241
(list street, number and municipality)
Decedent, then 26 years of Cig~, died OCTOBER 5 ,2001, at N['lfT'8r J,IiV-.
Decedent at death owned property with estimated values as follows:
(if domiciled in PA All personal property ......................................... $
(if not domiciled in PA Personal property in Pennsylvania .................... $
(if not domiciled in PA Personal property in County .............................. $
Value of real estate in Pennsylvania ........................................................................................ $
T atal ..................................................................................................................... $
43,780.00
43,780.00
Real Estate situated as follows:
Wherefore, Petitioner(s) respectfully request(s) the probate of the Last Will and Codicil(s) presented with this Petition and the grant of letters in
the appropriate form to the undersigned:
I:
Signature
Typed or printed name and residence
I
/~~ ;r- 0. -e.... ~- .-#
~
ERNEST J SOUDER,870 SHIPPENSBURG RD,NEWVILLE P
I?-Itf/- /0
Oath of Personal Representative
Commonwealth of Pennsylvania
County of CUMBERLAND
. 'The Petitioner(s) above-named swear(s) and affirm(s) that the statements in the foregoing Petition are true
cind correct to the best of tt)e knowledge and belief of Petitioner(s) and that, as personal representative(s) of the
Decedent, Petitioner(s)'wiW'well anc truly administer the estate according to law.
Sworn to and affirmed and siJbstribed ",".L .~ /~..-cr1 ""..--
before me this 31 s t day of
OCTOBER
7'7~U~~~f)A;/~
DECREE OF REGISTER
Estate of HENRY J SOUDER
~ ~' ~ t.,_.
also known as
Deceased
21-01-1009
No.
Social Security No: 180607994 Date of Death: 10/5/01
AND NOW, NOVEMBER 2 2001 , in consideration of the Petition on the
reverse side hereon, satisfactory proof having been presented before me,
IT IS DECREED that Letters 0 Testamentary !XI of Administration
are hereby granted- to ERNEST J SOUDER
((c.ta., d.b.n.c.t.; pendente lite; durante absentia; durante minoriate)
in the above estate and that the instrument(s), if any, dated .... .
described in the Petition be admitted to probate and filed of record as the Last Will of Decedent
FEES
Letters ....................................
Short Certificates(s) ...............
Renunciation ..........................
Extra Pages (
) ............ ..
LT. Roo.....................................
JCP Fee ..................'.. ............
Inventory ................................
Other ............................,........,
TOTAL............................ .$
$
I . ~
80.00
'.r .d,\1
7~7(l-:r~J:VJhJ ~)4-'r'l
~ er of Wills
$
$
$
$.
$
$
$
$
3.00
Signature
5.00
Attorney:
LD. No:
Address:
88.00
Telephone:
DATE FILED:
; .115 15 to certify that the information here given is correctly copied fron: an original certificate of deathdul~ filed with me as
Local Registrar. The original certificate will be forwarded to the State Vital Records Office for permanent filmg.
WARNING: It is illegal to duplicate this copy by photostat or photograph.
No.
~.--~. ~~~~
Local Registrar
Fee for this certificate, $2.00
p
7714070
OCT 1 0 1001
Date
21-01-1009
HIes. 1<< Rev. 1/91
COMMONWEALTH OF PENNSYLVANIA.. DEPARTMENT OF HEALTH" VITAL RECORDS
CERTIFICATE OF DEATH
(Coroner)
'RINT
I
,HENT
<INK
UNDER I DAY
Hours Mlnul..
Souder
DATE OF BIRTH
(Monlh. Day. ....r)
SEX
2. Male
STATE FILE NUMBER
SOCIAL SECURITY NUMBER
3. 180 60 7994
ORE OF DEATH (Month. Day. ....,)
~ October 5. 2001
J
BIRTHPLACE IC4y and
Sta'eor Foreign Country)
g:;tlyl 0
CITY. BOA
RACE - _.n Indian. Bloc!<. WMe. e'c.
(Speclly)
10.Whi te
SURVIVING SPOUSE
(M wile. give mllJden name)
DECEDENT'S USUAL OCCU"..,.ION
l:r=.;;;""~u~~ .'
o t .ollback Operator 1tb. Tmung Company
DeCEDENT'S MA,UNG ADDRESS (Street CilylTown. Slate. Zip CO(le) DECEDENT'S
ACTUAL
RESIDENCE
(See instructions
on _ SIde)
N c lor 1- ("HI
twp.
cilylbOro
PA 17241
,/
17013
ORE PRONOUNCED DEAD ~Montn. Day. '<W)
24. A M 2. October 5 f 2001
21. PART I: Enter tile _. injUriet or complicoltionll whicl\ caused lhe dell\tl. Do noIenlerthe mode 01 dying. such .. ..,dlac or resplralOry a"eel. _ or """"failure.
l.iol aNy one ...... on eaCh line.
Spring Ave
DATE SIGNED
(Month. Day. 'Year)
m. 23<:.
WAS CASE REFERRED 10 MEDICAL EXAMINER/CORONER?
",..!J NoD
H.
I Approxtmela
: InCertal between
! anN! .nd death
I
PART II: Other lignificant conditions contribullrIQ 10 death. but
not rasulllng In the underlylng.._ givan in PART I.
DUE 10 (OR AS A CONSEOUENCE OF):
b.
DUE 10 (OR AS A NSEOUENCE OF):
DUE 'It) (OR AS A CONSEOUENCE OF):
d.
WERE AU1O!'SY FINDINGS
~PRlOR1O
COMPLETION OF CAUSE
OF DEATH?
Natur.'
.
o
o
HomICide
Pandlng Investigation
o
Coroner
MANNER OF DERH
DATE OF INJURY
(Montn, Day, 'I\lar)
TIME OF INJURY
INJURY AT WORK?
-1J..
NoD
Accident
2IL 2....
ceJI'TWISl (CIled< onIyonel
'ClRTH'\'IllIG PHYSICIAN (Physician certifying c:auoe cede8lh wilen anolher phys.eian has pronounced deollh and complatad nero 23)
Totlle_DllllYk"""""""".___lOtIleC.uN(.'.ndftlannerasststed...,.....,..,...,......,............................ .
Suielde
ft.
Could not be_
OMl!OlCAL EXAMIHERICOfIONER
On the..... of ellMlln8tlon and/or Inv..tlg.tlon, In my opinion, de.th occurred at tile lime. d8te, ancI place, Ind due to the c.u..(a'and
_..ltltad........... _......................................................................................
"..
REGISTRAR'S SIGNATURE
~. ~'t.u..~
~ Ita... \ I 0 I
DATE SIGNED (Month. Day. ....,)
o t. 31d. October 8. 2001
NAME AND ADDRESS OF PERSON WttO COMPLETED CAUSE OF DEATH
(Item 27l TYIl8 or Prlnl Michael Lo Norris, Coroner
~ 6375 Basehore Road, Suite #1
~ n. Mechanicsburg, Pa. 17050
DATE FILED (Momh, Day, _)
C\. 9 ~OO\
34.
.~ AND ClRTIFYING PHYSICIAN (Phy1i<;en boIh pronounculll death and certifying to ceuoe 01 deIIlh)
Totlle_DlIllYIuloWIacIga.__atltle_.data. .ndplaca.__totllecauN(s,.nd_asl1ated.............,............
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
REV-1162 EX(11-96)
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
SOUDER ERNEST J
870 SHIPPENSBURG ROAD
NEWVILLE, PA 17241-9103
-------- fold
EST A TE INFORMATION: SSN: 1 80-60-7944
FILE NUMBER: 21-2001- 1009
DECEDENT NAME: SOUDER HENRY J
DA TE OF PAYMENT: 11/20/2001
POSTMARK DATE: 00/00/0000
COUNTY: CUMBERLAND
DATE OF DEATH: 10/05/2001
NO. CD 000542
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 I $300.00
I
I
I
I
I
I
I
I
TOTAL AMOUNT PAID:
$300.00
REMARKS: ERNEST J SOUDER
CHECK#107
SEAL
INITIALS: SK
RECEIVED BY:
REGISTER OF WILLS
MARY C. LEWIS
REGISTER OF WILLS
REV.1500 EX (6-00)
.....
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COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
~ 1. Original Return
o 4. Limited Estate
o 6. Decedent Died Testate (AttBch copy of Willi
D 9. Litigation Proceeds Received
/1--/7- Ie
REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
L"/.-
)0
FILE NUMBER
:2..L-fl.L
COUNTY CODE YEAR
SOCIAL SECURITY NUMBER
)~O- 0
__LlLO ~
NUMBER
7crC(
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
o 2. Supplemental Return
D 4a. Future Interest Compromise (date of death after 12-12-82)
D 7. Decedent Maintained a Living Trust (Attach copy of Trusl)
o 10. Spousal Poverty Credit (dale at death between 12-31-91 and 1-1-95)
D 3. Remainder Return (date 01 death prior to 12-13-82)
o 5. Federal Estate Tax Return Required
B. Total Number of Safe Deposit Boxes
o 11. Election to tax under Sec. 9113(A) (Attach Sch 0)
1. Real Estate (Schedule A)
2. Stocks and Bonds (Schedule B)
COMPLETE MAILING ADDRESS ,0 17
g7() 5A'ftfe-v\5b/;1.r'C; (J\d(
;V e t"J l/; Il e) ,f7(X 1 "1 :A '-I /
f,.../CJ r 1<..
~O!;--;2Jj6'
(1)
(2)
(3)
(4)
(5)
4. Mortgages & Notes Receivable (Schedule D)
3. Closely Held Corporation, Partnership or Sole-Proprietorship
5. Cash, Bank Deposits & Miscellaneous Personal Property
(Schedule E)
6. Jointly Owned Property (Schedule F) (6)
D Separate Billing Requested
z
o
5
~
!::
Q.
<t
o
w
0::
4''1'(;5"7] I J Y
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7)
(Schedule G or L)
8. Total Gross Assets (total Lines 1-7)
f
pol
= ~: I
::1 -,.:. :
a-
,1"
i,:
L~
"-,
--I.B-
OFFICIAL USE ONLY 1
I
I
d
......
:a
~;
:2:
CJ
<:
N
o
(9)
(10)
f '5, :J-C):L, (/O
, / 0' I cr 7 I <g J
)
13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax has not been
made (Schedule J)
14. Net Value Subject to Tax (Line 12 minus Line 13)
;r...-:.
(8)
J i,-/,5.:2.], ] t
(11)
(12)
(13)
11 ly,Lj-Lf1tKI
J1 .:;. t/. 0 7 ? ..J 7
/ - .
(14)
Ji
;;2J~ ) 0 7J ,57
1/
1,/7J,5/
/ I
If
j,17J,JI
"
(19)
9. Funeral Expenses & Administrative Costs (Schedule H)
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I)
11. Total Deductions (total Lines 9 & 10)
12. Net Value of Estate (Line B minus Line 11)
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
z
o
~
~
:::)
D..
::E
o
o
g
15. Amount of Line 14 taxable at the spousal tax
rate, or transfers under Sec. 9116 (a)(1.2)
16. Amount of Line 14 taxable at lineal rate
17, Amount of Line 14 taxable at sibling rate
18. Amount of Line 14 taxable at collateral rate
19. Tax Due
~ '?/ -
~j (J7],~ '}
x.O _ (15)
x .04(<) (16)
x .12 (17)
x .15 (18)
CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
20.0
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF () .
OLAC~e V
REV.150B EX + (1.97)
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
IT
FILE NUMBER
e proceeds were received by the estate. All property jointly-owned with the right of survivorship must be disclosed on Schedule F.
ITEM
NUMBER
1.
J-
)
If
5-
(;
7
DESCRIPTION
VALUE AT DATE
OF DEATH
Ii Lf);;290
7 ) ;;00
J 0) 000
Lfj9QO
8/ 000
5- 000
I
gL(
gg
FurJ
Fu rc2
Fo rc2
(r CA.. C I<-
8roV\co
111A5fwv:'l 1-'1. }O;L
)'ler lXJj J;' If- /J ~rJ
ir; Chev/ ;-/C ~\c-k~?
/'1e c..llC<."l/'c 5 7;o/J
)hUf~ f'L~ t'f ~~~-j-
el, fcJ(.''''J ;teet fC.. """'''-'')
ell
)J~-I~o ~<<( aJa(,1 J(
;J ~I..V VI' {{ ~
1(4J,J%
TOTAL (Also enteron line 5, Recapitulation) $ If r; .;:z '] . J,g'
(If more space is needed, insert additional sheets of the same size)
REV-1511 EX+ (12-99)
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF ()
5[) I^~e r )
FILE NUMBER
He","-V'v J
/ Debts of decedent must be reported on Schedule 1.
ITEM
NUMBER
A.
DESCRIPTION
FUNERAL EXPENSES:
1. c;,J'JE?-r FIA.'^-R...V' 0.... \
J-- C \A "'"'- h e v--I 0\ "" k7
Ho,,,"\-e. CCcdke.t} Va...../f of ferv'''c.~0
V t( ll-€ j 11 f "'""-ev-; CA. l G-ft 1/';' ~ V\
( '-0+/ Of~lA. Cf- (((Of! J f0.c.k)
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Representative(s)
Social Security Number(s)/EIN Number of Personal Representative(s)
Street Address
City _
State __ Zip
Year(s) Commission Paid:
2. Attorney Fees
3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant
Street Address
City
State _ Zip
Relationship of Claimant to Decedent
4. Probate Fees
5. Accountant's Fees
6. Tax Return Preparer's Fees
7.
AMOUNT
tf 0077
.2)S7:J
(If more space IS neededj Insert additional sheets of the same size)
TOTAL (Also enter on line 9, Recapitulation) $ 2" j 75' 2.. 00
REV.1512 EX'" (1.97)
SCHEDULE I
COMMONWEALTH OF PENNSYLVANIA DEBTS OF DECEDENT,
INH~~~~~~~i DT:&~~~~RN MORTGAGE LIABILITIES, & LIENS
ESTATE OF ()
50lAcXer HeV\ Vy' ,7
) I
Include unreimbursed medical expenses.
FILE NUMBER
ITEM
NUMBER DESCRIPTION AMOUNT
1. 1/ For; rUff. r- Vvt +y 1...8;","- w !rCil"""",eor f ;V~ +I\O~",--l
/j
a3c:t""K s-) 7J6 I ]5-
A He~vf Pc-<- + y fa. r f-j 3) ]f.(S-, 3 J
) j\/ f.- x- tc I LC~{( (ftld V\. -e) 4.)-{) I 10
L( Peft of fab(} r 5S- I co
S- Dre jJ e-/ ~~/Jt'J fVlf~( '/ '10 3 · ? 0
cJ.-O '7, J 5--
0 T5o< t.--J,' V' '<- { ~ 5 5
TOTAL (Also enter on line 10, Recapitulation) $ jo/97.?1
If m e ac' . . /
( or sp e IS needed, Insert additional sheets of the same size)
REV-1513 EX+ (9-00.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE J
BENEFICIARIES
ESTATE OF ()
/' 0 '^- ;:;K e r /-If:!. '-'\ 'r V J
NAME AN:ADDRESS OF 'RSON(S) RECEIVING PROPERTY
TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under
Sec. 9116 (a) (1.2)]
1. )ov,-J2~ r ) ~rn-'ft;1-
NUMBER
I
-7
FILE NUMBER
RELATIONSHIP TO DECEDENT
Do Not List Trustee(s)
F 0 +f..t "C If
AMOUNT OR SHARE
OF ESTATE
/ tJCJ ?CJ
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET
II NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE
1.
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
1.
TOTAL OF PART I1- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $
(If more space is needed, insert additional sheets of the same size)
/'l.-If -;0
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
DEPT. Z80601
HARRISBURG, PA 171Z8-D6Dl
NOTICE OF INHERITANCE TAX
APPRAISE"ENT1 ALLOWANCE OR DISA~LOWANCE
OF DEDUCTIONS AND ASSESS"ENT ~F TAX
Recor(~!t::'...~
RegiDtl.Y ,
r,t
l...;;
DATE
ESTATE OF
DATE OF DEAtH
FILE NUMBER
COUNTY
ACN
01-14-2002
SOUDER
10-05-2001
21 01-1009
CUMBERLAND
101
-02 JAN 18 P 3 : 1 5
ERNEST J SOUDER
870 SHIPPENSBURG RD CW';' ,-
NEWVILLE PA C',iti~6~;;CL
*7~
REV-1547 EX AFP U2-DDl
HENRY
J
Allount Rellitted
) CHANGED
U)
(2)
(3)
(4)
(5)
(6)
(7)
.00
.00
.00
.00
44~523.38
.00
.00
(8)
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE1 PA 17013
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~
REY=is"4-j-ix-AFP-ri'Z":ool--Nc)i"-ici--oF-'rtiHEifiTAircE-TAx-;fpPRAisEirENT~--AL1-oNANcE-bR-----------------
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF SOUDER HENRY J FILE NO. 21 01-1009 ACN 101 DATE 01-14-2002
TAX RETURN WAS: (X) ACCEPTED AS FILED
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. Real Estate (Schedule A)
2. Stocks and Bonds (Schedule B)
3. Closely Held Stock/Partnership Interest (Schedule C)
4. "ortgages/Notes Receivable (Schedule D)
5. Cash/Bank Deposits,"isc. Personal Property (Schedule E)
6. Jointly Owned Property (Schedule F)
7. Transfers (Schedule G)
8. Total Assets
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funeral Expenses/Adll. Costs/"isc. Expenses (Schedule H)
10. Debts/"ortgage Liabilities/Liens (Schedule I)
11. Total Deductions
12. Net Value of Tax Return
13. Charitable/Governllental Bequests; Non-elected 9113 Trusts (Schedule J)
14. Net Value of Estate Subiect to Tax
(9)
UO)
81252.00
NOTE: To insure proper
credit to your accountl
submit the upper portion
of this form with your
tax payment.
441523.38
18.44Q 8]
261073.57
.00
261073.57
NOTE: I~ an assessment was issued previously, lines 14, 15 and/or 16, 17, 18 and 19 will
re~lect ~igures that include the total o~ ALL returns assessed to date.
ASSESSMENT OF TAX:
IS. Amount of Line 14 at Spousal rate
16. Amount of Line 14 taxable at Lineal/Class A rate
17. Amount of Line 14 at Sibling rate
18. Amount of Line 14 taxable at Collateral/Class B rate
19. Principal Tax Due
10.197.81
Ul)
(12)
(13)
(14)
(15) .00 X 00 = .00
(16) 261073.57 X 045 = 11173.31
(17) .00 X 12 = .00
(8) .00 X 15 = .00
(9)= 1..173.31
TAX CREDITS:
PAY"ENT RECEIPT DISCOUNT (+) A"OUNT PAID
DATE NUlfBER INTEREST/PEN PAID (-)
11-20-2001 CDOO0542 15.79 300.00
PAYMENT MUST BE MADE BY 07-05-2002~. TOTAL TAX CREDIT 315.79
BALANCE OF TAX DUE 857.52
INTEREST AND PEN. .00
TOTAL DUE 857.52
. IF PAID AFTER DATE INDICATED 1 SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
IF TOTAL DUE IS LESS THAN $1.. NO PAY"ENT IS REQUIRED.
IF TOTAL DUE IS REfLECTED AS A "CREDIT.. (CR).. YOU "AY BE DUE
A REFUND. SEE REVERSE SIDE Of THIS FOR" FOR INSTRUCTIONS.)
~
Name of Decedent:
CERTIFICATION OF NOTICE UNDER RULE 5.6(a)
5'~'A J er J Hi? Vl f-V _ T
/ /
Date of Death:
j OcT
~O(
Will No.
Admin. No. ~J. OJ - OIDOC(
To the Register:
I certify that notice of (beneficial interest) estate administration required by Rule 5.6(a) of the Orphans' Court Rules was
served on or mailed to the following beneficiaries of the above-captioned estate on
Name
Address
501,/( J-e_~) };r-Vl-e sf J
?I 7.0 ) t. '<J' JYe VI d:J v. r-j tiC /
NfIwJVr~/le~ ~ /7;2.l.{f
Notice has now been given to all persons entitled thereto under Rule 5.6(a) except
Date:
J 0 J;, '"
tJd-
p . , /...
~-'~V~
Signature t
Name Err v. <_ J -t :r fa {.r, cf f!_ r
L,~j
-=:::t
~
Address
??o )tl'ft'I'~,)lv'J Iii
/Vet,jV,' I (e i ~'- J'7:LY (
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Telephone ("7) 6tJS---.;2 Js-Y (~)(Jr t-)
t71?) ? 7b -- 77? S- (HfJ....., e.)
Capacity: -L Personal Representative
_Counsel for personal representative
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
REV-1162 EX(11-96)
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
SOUDER ERNEST J
870 SHIPPENSBURG ROAD
NEWVILLE, PA 17241-9103
-------- fold
ESTATE INFORMATION: SSN: 180-60-7944
FILE NUMBER: 2101-1009
DECEDENT NAME: SOUDER HENRY J
DA TE OF PAYMENT: 02/12/2002
POSTMARK DATE: 02/11/2002
COUNTY: CUMBERLAND
DATE OF DEATH: 10/05/2001
NO. CD 000854
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 I $873.31
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TOTAL AMOUNT PAID:
REMARKS: ERNEST J SOUDER
CHECK# 6579
SEAL
INITIALS: AC
RECEIVED BY:
REGISTER OF WILLS
$873.31
MARY C. LEWIS
REGISTER OF WILLS
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BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
DEPT. Z80601
HARRISBURG, PA 171Z8-0601
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
INHERITANCE TAX
STATEMENT OF ACCOUNT
*
REV-li07 EX AFP (01-02)
R(-;i.~o..
.02 APR-1
mo :02
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
03-18-2002
SOUDER
10-05-2001
21 01-1009
CUMBERLAND
101
HENRY
J
ERNEST J SOUDER
870 SHIPPENSBURG RD
NEWVILLE PA ~~41
Ctanb~. .
Allount R_itted
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
NOTE: To insure proper credit to your account, subllit the upper portion of this forll with your tax paYllent.
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~
REY=i6oj-Ex--AFP--lol-:021-------...--INHEii,.-ANcE'-fAx-STA-fiME-N'f.OF-ACCouirf--.-..---------------------
ESTATE OF SOUDER HENRY J FILE NO. 21 01-1009 ACN 101 DATE 03-18-2002
THIS STATE"ENT IS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN IN THE NA"ED ESTATE. SHOWN BELOW
IS A SUHHARY OF THE PRINCIPAL TAX DUE, APPLICATION OF ALL PAY"ENTS, THE CURRENT BALANCE, AND, IF APPLICABLE,
A PROJECTED INTEREST FIGURE.
DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 01-14-2002
P R I NC I PAL TAX DU E : ..........................................................................................................................................................................................................................
1,173.31
PAYMENTS (TAX CREDITS):
PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
11-20-2001 CDOO0542 15.79 300.00
02-11-2002 CDOO0854 .00 873.31
TOTAL TAX CREDIT 1,189.10
BALANCE OF TAX DUE 15.79CR
INTEREST AND PEN. .00
. IF PAID AFTER THIS DATE, SEE REVERSE TOTAL DUE 15.79CR
SIDE FOR CALCULATION OF ADDITIONAL INTEREST.
( IF TOTAL DUE IS LESS THAN $1,
NO PAYMENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR),
YOU HAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS. )
"'.. ' ..A.
STATUS REPORT UNDER RULE 6.12
Name of Decedent: H f>."'- 7' J ),.,... fe r
Date of Death: s- (J (' -f ~(?O I
~Ioh
Will No.:
Admin. No.: ;2 00 I - CJ / 00 9
Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the
following with respect to completion of the administration of the above-captioned estate:
1. State whether administration of the estate is complete:
Yes,N No 0
2. If the answer is No, state when the personal representative reasonably believes
that the administration will be complete:
3. lfthe answer to No.1 is Yes, state the following:
a. Did the personal representative file a final account with the Court?
Yes _ No %.
b. The separate Orphans' Court No. (if any) for the personal representative's
account is: :J-OO' - ~ I 00 9
c. Did the personal representative state an account informally to the parties
in interest? Yes Pi No 0
(Y)
c. Copies of receipts, releases, joinders and approval of formal or
informal accounts may be filed with the Clerk of the Orphans' Court
and may be attached to this report.
s~/~
br-V\.efT J JoJer
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Date: ~J AIAJ eJ 3
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Address
(?(7) ?7~ - rz7?~
Telephone No.
Capacity: IS[Personal Representative
OCounsel for personal representative